Health Clinics of Utah

NO SHOW POLICY

The patients have a responsibility to keep their scheduled appointments and to arrive on time.

C If you are unable to keep your appointment, it is your responsibility to call and cancel your appointment at least 24 HOURS before the appointment.

C After one NO SHOW to a regular appointment, you will have to pay a $5.00 fee prior to scheduling another appointment. If a patient no shows multiple times we have the option to tell them that they have lost their scheduling privileges but they are welcome to come in and wait for an appointment opening or a cancellation.

C If you NO SHOW for a Form 20 medical report, you will have to pay a $15.00 fee prior to scheduling another appointment. If you NO SHOW for a Form 1 medical report, you will have to pay a $10.00 fee prior to scheduling another appointment. If you NO SHOW on the rescheduled appointment, no further appointments will be made. Your eligibility caseworker will be notified of your NO SHOW problem and appropriate action will be taken.

C After only one NO SHOW to a volunteer specialist appointment, you will have to pay a $10.00 fee prior to scheduling another appointment with any volunteer.

C REGULAR CLINIC HOURS: Monday to Friday 7:30 AM to 5:00 PM, except legal

holidays.

*AFTER HOURS CLINIC*

If you suddenly become ill or need urgent care, you may be seen in our clinic Monday through Friday evening from 4:30 PM to 6:00 PM on a walk-in basis. This time is not suitable for forms, routine medical care, or new patient work-ups. These types of service require an appointment with a provider during regular clinic hours. If you come to night clinic with a medical condition that our staff deems non-emergent, you may be asked to schedule an appointment and return later. If you NO SHOW during the day, you will not be seen at our AFTER HOURS CLINIC for routine medical care the day of the NO SHOW.

Remember that appointments are required during regular clinic hours.

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Signature or mark of patient Date